Funding the NHS

By Bernadette Meaden

June 25, 2018

The idea of introducing a charge for a visit to your GP or A&E is now frequently floated. Happily, on 25 June 2018 the BMA's main policy-making body, the annual representative meeting, voted against the principle of co-payments. Ahead of the BMA vote, Professor Karel Sikora, Dean of the Medical School at Buckinghamshire University, the only private University in the UK, said, "I hope the BMA votes in favour of this…They voted against the NHS at the start - they’re not all communists."

And Sir Christopher Chope, who famously blocked a Private Member’s Bill on upskirting, has a Private Member’s Bill of his own on the books, which is ‘A Bill to make provision for co-funding and for the extension of co-payment for NHS services in England’.

People who, perhaps, have never really embraced the idea of a comprehensive, universal health service funded solely through general taxation, are trying to persuade the public that the NHS is ‘unsustainable’, a money pit which could bankrupt the country. This is not true, but there is a risk that a constant stream of misleading and alarmist stories may persuade sections of the public that the NHS is a luxury Britain can no longer afford.

Recently, for instance, an IFS report on NHS funding was reported simplistically as ‘The NHS will need an extra £2,000 a year from every household in order to function properly’. This must have alarmed many people for whom £2000 would represent a large percentage of their income.

We do need to spend more on health and social care – but suggesting every household must contribute the same amount is misleading. This would be highly regressive. There are plenty of ways to fund higher spending which would not hit those who can’t afford it. For example, the New Economics Foundation recently explained that abolishing the Upper Earnings Limit of employee National Insurance Contributions would raise £11.1billion per year by 2023/?24 – “more than half of the £20 billion the government has promised”. This would be eminently fair, and would simply ensure that the richest 15 per cent of taxpayers contribute just as much proportionally to the NHS as everybody else – which they currently do not.

It is also important to view spending on the NHS and social care not as money down the drain, but as an investment in the economy which brings returns. As Richard Murphy explains, £20 billion spent on the NHS means £20 billion extra economic activity in the UK economy. Much of this will be returned in tax, and NHS wages will be spent, generating more tax and more economic activity. Murphy concludes, “In other words, the additional spend pays for itself, at the very least in large part. And it is unforgivable that senior political correspondents do not have even this most basic of economic knowledge.”

And if, heaven forbid, spending on the NHS and social care caused the budget deficit to rise – would that be a bad thing? No. The desirability of eliminating the budget deficit has been based on the fallacy that a nation is like a household. But a nation is nothing like a household, and pretending it is has brought our public services to their knees.

This article in Forbes magazine, ‘Why You Should Love Government Deficits’ explains it in terms that could not be more simple - “government deficits create private sector wealth, while government surpluses drain it.” So let us stop accepting bogus arguments that the NHS, social care, or anything we really need as a country, is unaffordable.

But back to those co-payments. One reason given for introducing charges for a GP visit was to reduce growing demand on hard-pressed doctors. This is understandable, but would obviously have the biggest impact on people with the lowest incomes. We already know that some parents are struggling to feed their children. If it comes to a choice between buying food and seeing the GP, they may struggle on with the niggly cough, or the nagging pain that is the sign of something sinister, but will be diagnosed too late. And then, if we really must think in terms of money, it will not only be bad news for the patient, it will be more expensive to treat.

One way the government could reduce demands on the NHS (apart from adequately funding social care) is to stop actively making people ill. Recently Dr Chris Ritchieson, chairman of NHS West Cheshire Clinical Commissioning Group, made a link between 'fit for work' assessments and a growing number of residents in need of support for mental health issues. He said: “Anecdotally, assessments have had an impact in general practice. A number of people thankfully don’t reach this level of crisis but do raise serious concerns related to this issue. It’s certainly something that has increased dramatically in recent years.”

Every element of welfare reform and austerity has contributed to making people poorer and sicker. If anyone doubts the devastating effect benefit sanctions can have on a person’s health I would urge them to read this written evidence submitted to the benefit sanctions inquiry. The details are extremely harrowing, but in brief, a previously healthy 45 year old man who had the misfortune to be made redundant has had his physical and mental health ruined, including an attempt to take his own life, requiring hospitalisation. He says simply, ‘I had none of these problems before I claimed benefit.’

If the government stopped impoverishing people, stopped imposing unbearable stress and inflicting hunger as a punishment, that would reduce demand on GPs.

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